1. The US already did the affirmative, no risk of their advantages.
Reuters, 6-7-07 [“U.S. gives Zimbabwe $18 mln for HIV/AIDS drugs,” http://www.alertnet.org/thenews/newsdesk/L07827370.htm] Rein
The United States government said on Thursday it would provide $18 million worth of life-saving anti-retroviral (ARV) drugs to help Zimbabwe add 40,000 people to its HIV/AIDS treatment programme. The southern African country is among the worst hit by the epidemic, which kills more than 3,000 people every week and accounts for 70 percent of hospital admissions. In a joint announcement, U.S. ambassador Christopher Dell and Zimbabwe's Minister of Health David Parirenyatwa said ARVs worth $15 million would be made available over three years, while $3 million would be used to acquire rapid HIV testing kits over the same period. Parirenyatwa said the additional drugs would increase the total number of people on the government's ARV scheme from the current 81,000. The government says at least 340,000 people need ARVs. Dell said the U.S government had urged other donors to help Zimbabwe's battle against the HIV/AIDS epidemic. "This initial programme is for three years and we hope that during that time, other donors and the Global Fund will be in a position to provide additional support," Dell said. Zimbabwe, despite its deep recession, has also become one of the few places on the continent where the HIV prevalence rate has gone down. It has declined to 18.1 percent last year from 25 percent six years ago.
2. Aid agencies have concentrated on HIV/AIDS funding despite sanctions.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p. 4-5 [T Chenoweth])
Another critical effect of the land reform is the serious deterioration of the Government’s relationship with some western countries and consecutive restrictions to foreign aid. Indeed, whereas targeted sanctions were taken against Zimbabwe and direct support provided to some opposition movements, some major donors and financial institutions have restricted their assistance in different ways after 2000: • most of their cooperation and development funding to the country has been curtailed and the assistance been concentrated on emergency relief, mostly HIV/AIDS, food aid, water & sanitation and only later on agriculture. • the resettlement areas are excluded from the main aid packages whereas they have a greater agricultural potential due to more favourable agroecological conditions and the larger size of the land holdings. • all assistance is channelled through international organisations, which prevents any institutional support to Government services.
3. No solvency – brain drain kills the health sector.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.20 [T Chenoweth])
Few years ago, the Government of Zimbabwe instituted a 3% tax levy to generate domestic resources for fighting HIV/AIDS through treatment and prevention, but this remains far from sufficient to adequately tackle the disease. Furthermore, the economic crisis, resulting in brain drain and deteriorating infrastructures, combined with the death toll due to HIV/AIDS contributes to the rapid depletion of the health and social services.
4. The Silent Embargo –
A. You solve zero of the case – the NGOs the plan assists have created a silent embargo which restricts HIV/AIDS support even if they try to provide more.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.5 [T Chenoweth])
Indeed, HIV/AIDS and other diseases kill today far more than malnutrition which has remained in Zimbabwe at one of the lowest levels in Africa. Yet, most media and NGOs keep focusing on food issues, the bulk of the assistance remains food aid, and a silent embargo is maintained on HIV/AIDS and institutional support funding for health services. It seems essential today for NGOs to depoliticize humanitarian issues in Zimbabwe. NGOs interventions may aim not only at bringing assistance to the people but also at improving the working environment in the country; this should include the promotion of a shared understanding of the challenges faced by the communities and of the priorities of the assistance. In order to do so, it is paramount to reject and to fight any form of discrimination in the assistance, whether it comes from the Government or from donors. It is also essential to produce and disseminate objective information and analysis on livelihood situations in order to generate adequate funding and to promote appropriate relief and recovery interventions that will benefit to the vulnerable people of Zimbabwe.
B. It’s proven – your solvency advocates a change in NGO policy as well.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.5 [T Chenoweth])
• To the NGOs: Relief agencies shall strive to get out of the political arena and give priority to relief, assistance and recovery activities. This can be achieved through the compliance with the humanitarian principles such as non-discrimination and impartiality, and through sharing information and analysis related to livelihoods situations.
C. Even if we lose that argument NGOs will focus exclusively on communal areas, ignoring the problem.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.23 [T Chenoweth])
Another aspect of the politicization of the assistance is that donors and NGOs focus almost exclusively their assistance on communal areas. In 2003, Save The Children UK called “donors and humanitarian agencies to apply the humanitarian principle of need and impartiality in implementing their programmes, and [to] include resettlement areas in their activities.” 10 Indeed, donors have been generally opposed to support programmes in these areas, in line with their opposition to the land reform process. Apparently, NGOs were also reluctant to intervene because of donors’ influence but also because of their fears around the highly controversial nature of the land reform programme.
5. Alternate causality – the health system is failing and fueling emergence of other diseases.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.10 [T Chenoweth])
The lack of resources but also the decline of the health system explain these figures; as a matter of fact, the quality and the access to health services in Zimbabwe have been deteriorating over the recent years as a result of under funding, emigration of health staff, and the impact of HIV/AIDS. The maternal mortality ratio, a good indicator of the quality of health services, deteriorated from 610 per 100,000 live births in 1994 to 1100 per 100,000 live births in 2000. Child mortality has doubled from 59 to 123 per 1,000 live births between 1989 and 2004 13. Besides, a number of infectious and epidemic prone diseases have re-emerged in the past few years: • one of the country’s worst ever years as regards malaria was 2003-2004, as a result of failure of the main prevention programme of residual spraying. Already this year there have been more than 650,000 cases and more than 1000 deaths. • cholera has occurred in Zimbabwe every year since 1998, with very high case fatality rates during outbreaks. • Zimbabwe is one of the most affected countries as regards tuberculosis: incidence has increased five-fold between 1992 and 2002. The rise has been attributed mainly to HIV; 80% of TB cases are estimated to be HIV positive. • lastly, rabies and anthrax have made major comebacks as a direct result of the current decline in the capacity for the health care delivery services. Prevention of both diseases required strong intersectoral action, which is currently lacking, regular and widespread vaccine availability and appropriate prevention and control programmes.
6. NGOs fail – health assistance in Zimbabwe is only effective through a governmental framework.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.23 [T Chenoweth])
A last crucial difference in the way assistance is provided to Zimbabwe compared to other countries in the region is that funds are channelled mainly, if not only, to non governmental channels such as NGOs and UN agencies. Yet, certain sectors, especially health, but also education or agriculture can hardly make any progress out of a governmental framework.
7. Turn: NGOs fail – subcontractors will cause the plan to backfire – they purposely fail to ensure continuing business.
Roger Bate, Economist Roger Bate researches U.S. aid policy in Africa, evaluating USAID, Areas of focus: health policy and endemic diseases in developing countries (more quals can be added); 1-07 (“USAID's health challenge: improving US foreign assistance,” Journal Of The Royal Society Of Medicine Volume 100:29-33, http://www.jrsm.org/cgi/content/full/100/1/29 [T Chenoweth])
USAID provides technical guidance to poor countries' health departments in public health policy and pharmaceutical procurement—as well as very strong support for family planning programs. But it has not been that effective, and a key reason is that the Administrators of USAID have always had their hands tied in several ways. After the Cold War, the conservative hold on US Congressional power meant that foreign assistance was largely justified by ensuring that it benefited US taxpayers and employed the competitive advantages of the private sector. But this approach has unintentionally backfired. As concerns about serious corruption in developing countries led USAID away from ‘budget support’ and similar programs, USAID was reoriented to employ primarily US contractors and continue to source development commodities in the US. These for-profit organizations understandably refused to lower chances of future contracts by actually building local capacity in any meaningful way. And without the resources or political will at USAID to measure performance, contractors also neglected to purchase key commodities and demonstrate efficacy. They simply promoted, and often did not actually buy, the drugs to treat disease. Furthermore, as the contractors became larger and more able to exploit the contract system of USAID, tendering became less competitive. To make matters worse, the ability of the current Administrator, Randall Tobias, to effectively juggle USAID's health priorities among eighteen separate aid accounts addressing health issues and food aid programs, as well as navigate counter-narcotics assistance and military training, is by no means assured—especially since he does not control all of them. The apparent systemic incoherence among US aid programs makes the likelihood of further fragmentation within USAID's disease control programs, as well as the politicization of aid delivery, quite possible.10 Randall Tobias may well possess the coherent vision and sound technical knowledge that his position requires, but it is possible that, amid competing demands in the US's ever-evolving foreign aid policy, success may evade him.
8. Alternate causalities – conflict, development, debt, politics, and class divisions all fuel the AIDS crisis.
Andrew Price-Smith, assistant professor of Environmental science and policy, and John Daly – Your Authors, associate professor of public administration, July 2004 (Downward Spiral HIV AIDS State Capacity and political conflict in Zimbabwe, http://www.usip.org/pubs /peaceworks/pwks53.pdf
4. Reexamine development priorities. As noted above, certain development projects (notably, large construction projects) frequently take men away from their families, leading to widespread demand and opportunities for commercial sex. A pilot project in Cameroon created special camps where workers could live with their families, reducing the incentive to engage in risky behavior. USAID and others should include similar practices within their major construction project proposals (e.g., for dams, road construction, and other major infrastructure improvements). Moreover, U.S. development aid to regions where HIV/AIDS is flourishing should include specific strategies to reduce risky sexual behavior. 5. Invest in education. The United States should provide targeted assistance to reduce school fees, which will help families who have lost a breadwinner to keep their children in school. The education of AIDS orphans is vital to prevent future criminality and radicalization and to foster a productive and hopeful future for these dispossessed youth. Targeted assistance programs should be created to provide the basic necessities of life and develop human capital within orphan cohorts. 6. Preservation of smallholder agriculture. Indigent farms in rural sectors of southern Africa serve as the primary food source for their households. In the early years of this century, families in Zimbabwe and other southern African nations have had to contend with the consequences not only of the HIV/AIDS epidemic but also of drought. HIV/AIDS denudes household resources (both financial and labor) and inhibits house members from planting, tending to, and harvesting their crops. The catastrophic effects of the HIV/AIDS epidemic on subsistence families have been compounded by climatic conditions, with the result that the Zimbabwean countryside is fast becoming populated by widows and orphans. The United States and its allies should advocate the extensive revision of land-tenure arrangements to help protect these families. Donor countries should also emphasize crop diversification and improved access to essential production factors, such as land, labor, capital, management skills, and draft animals. The U.S. government can also offer direct assistance through the Peace Corps and through U.S. Department of Agriculture programs designed to help these families. 7. Promote sustainable distribution of resources within Zimbabwean society. The magnitude of the HIV/AIDS epidemic is likely to further widen class divisions within Zim-babwe and intensify deprivation for the lower and middle classes, who bear the greatest burden of the disease. As the severity of the disease increases and suffering grows more widespread, society as a whole may adopt an attitude of living for today and neglect-ing the future. Such an atmosphere breeds lawlessness and a loss of respect for the interests of others, which in turn encourages societal breakdown. If further erosion of the cohesion of Zimbabwean society is to be avoided, the United States and other donor countries must advocate greater distribution of economic resources to offset the growing sense of hopelessness and injustice. Highly skewed distributions of basic resources (e.g., food, shelter, education, and medical care) seriously undermine the stability of the social order. Moreover, recent research suggests that increasing equity in the national distribution of income will slow the further spread of disease throughout affected societies.80 8. Develop improved partnerships within the private sector. Zimbabwean NGOs and community health service organizations should be encouraged to collaborate more closely with Zimbabwe’s business community. NGO-business partnerships can be designed to promote greater educational awareness about HIV/AIDS, to provide a mechanism for victim and family counseling, and to encourage destigmatization of individuals infected with the disease. The United States can take the lead in this area by encouraging U.S. corporations active in southern Africa (e.g., Kellogg, Coca-Cola, and Microsoft) to continue sharing their resources and expertise to help promote administrative efficiencies and improved program service delivery within the business sector. Zimbabwean businesses stand to benefit from these partnerships by maintaining a more productive workforce, reducing the costs to themselves and their employees of health care, and improving planning for the eventual outplacement and replacement of employees in declining health. 9. Foster peace in sub-Saharan Africa. Conflict often serves as a disease amplifier, with deployed troops acting as vectors for disease transmission. Certainly, the myriad conflicts now being fought in Africa foster the expansion of the HIV/AIDS epidemic. The United States should increase its mediatory efforts to bring peace to the region. Such a strategy would not only promote stability and democracy in southern Africa but also facilitate the containment of the epidemic by reducing the need for troop deployments. At the same time, the United States should expand its collaborative programs with African military forces to educate soldiers about HIV transmission and safe-sex practices, and should promote mandatory testing for all members of the armed forces. Although UN legislation prohibits HIV-infected forces from serving as UN peacekeepers, this rule is often ignored, and thus peacekeeping forces often serve as vectors of transmission. The United States should do all it can (e.g., through the provision of technical support and support for further research) to ensure that all participants in multilateral peacekeeping operations are free of HIV/AIDS and other communicable diseases. 10. Support debt relief. Endogenous efforts to bring the HIV/AIDS epidemic under control are severely inhibited by the high levels of international indebtedness plaguing developing countries in general and sub-Saharan African countries in particular. Servicing those debts draws monies away from programs and institutional sectors—such as education and health—that can alleviate the spread of HIV/AIDS. The U.S. government should make a high priority of a strategy of debt relief for seriously affected countries (which might be defined as nations with HIV seroprevalence levels above 5 percent). Such relief should be contingent on the redirection of funds toward HIV/AIDS suppression—in essence, swapping debt relief for AIDS relief. Similar strategies have been used to encourage countries to protect endangered ecosystems. In the case of Zimbabwe, debt relief should be contingent on government reforms to bring Zimbabwe in line with accepted international democratic practices (e.g., freedom of speech and association, adherence to international human rights standards, and transparency in the use of government resources). Offers of debt relief should continue to be communicated through unofficial and secondary lines of communication (e.g., through other southern African governments) and should stress that the price of debt relief is political reform. 11. Foster political leadership in Zimbabwe in the war against HIV/AIDS. Preliminary evidence suggests that the advocacy of prevention by endogenous political elites is extremely successful in reducing HIV infection rates. The most successful models for the developing world are presently Uganda and Thailand, where political elites have used their power to educate the population and have encouraged an environment to support initiatives that control the spread of HIV without violating individual rights. The United States and its allies should encourage the Mugabe regime to adopt the Ugandan model of HIV suppression, which seems to be highly effective in societies of moderate to low state capacity. This would involve the mobilization of political elites (both ZANU-PF and MDC) to spread the word throughout the country about how to lower transmission rates through behavioral modification. Requisite programs would include education, voluntary counseling and testing, promotion of safe-sex practices, treatment of other STDs that act as gateways for HIV transmission, and increased efforts to destigmatize the disease and to promote basic human rights.
Reuters, 6-7-07 [“U.S. gives Zimbabwe $18 mln for HIV/AIDS drugs,” http://www.alertnet.org/thenews/newsdesk/L07827370.htm] Rein
The United States government said on Thursday it would provide $18 million worth of life-saving anti-retroviral (ARV) drugs to help Zimbabwe add 40,000 people to its HIV/AIDS treatment programme. The southern African country is among the worst hit by the epidemic, which kills more than 3,000 people every week and accounts for 70 percent of hospital admissions. In a joint announcement, U.S. ambassador Christopher Dell and Zimbabwe's Minister of Health David Parirenyatwa said ARVs worth $15 million would be made available over three years, while $3 million would be used to acquire rapid HIV testing kits over the same period. Parirenyatwa said the additional drugs would increase the total number of people on the government's ARV scheme from the current 81,000. The government says at least 340,000 people need ARVs. Dell said the U.S government had urged other donors to help Zimbabwe's battle against the HIV/AIDS epidemic. "This initial programme is for three years and we hope that during that time, other donors and the Global Fund will be in a position to provide additional support," Dell said. Zimbabwe, despite its deep recession, has also become one of the few places on the continent where the HIV prevalence rate has gone down. It has declined to 18.1 percent last year from 25 percent six years ago.
2. Aid agencies have concentrated on HIV/AIDS funding despite sanctions.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p. 4-5 [T Chenoweth])
Another critical effect of the land reform is the serious deterioration of the Government’s relationship with some western countries and consecutive restrictions to foreign aid. Indeed, whereas targeted sanctions were taken against Zimbabwe and direct support provided to some opposition movements, some major donors and financial institutions have restricted their assistance in different ways after 2000: • most of their cooperation and development funding to the country has been curtailed and the assistance been concentrated on emergency relief, mostly HIV/AIDS, food aid, water & sanitation and only later on agriculture. • the resettlement areas are excluded from the main aid packages whereas they have a greater agricultural potential due to more favourable agroecological conditions and the larger size of the land holdings. • all assistance is channelled through international organisations, which prevents any institutional support to Government services.
3. No solvency – brain drain kills the health sector.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.20 [T Chenoweth])
Few years ago, the Government of Zimbabwe instituted a 3% tax levy to generate domestic resources for fighting HIV/AIDS through treatment and prevention, but this remains far from sufficient to adequately tackle the disease. Furthermore, the economic crisis, resulting in brain drain and deteriorating infrastructures, combined with the death toll due to HIV/AIDS contributes to the rapid depletion of the health and social services.
4. The Silent Embargo –
A. You solve zero of the case – the NGOs the plan assists have created a silent embargo which restricts HIV/AIDS support even if they try to provide more.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.5 [T Chenoweth])
Indeed, HIV/AIDS and other diseases kill today far more than malnutrition which has remained in Zimbabwe at one of the lowest levels in Africa. Yet, most media and NGOs keep focusing on food issues, the bulk of the assistance remains food aid, and a silent embargo is maintained on HIV/AIDS and institutional support funding for health services. It seems essential today for NGOs to depoliticize humanitarian issues in Zimbabwe. NGOs interventions may aim not only at bringing assistance to the people but also at improving the working environment in the country; this should include the promotion of a shared understanding of the challenges faced by the communities and of the priorities of the assistance. In order to do so, it is paramount to reject and to fight any form of discrimination in the assistance, whether it comes from the Government or from donors. It is also essential to produce and disseminate objective information and analysis on livelihood situations in order to generate adequate funding and to promote appropriate relief and recovery interventions that will benefit to the vulnerable people of Zimbabwe.
B. It’s proven – your solvency advocates a change in NGO policy as well.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.5 [T Chenoweth])
• To the NGOs: Relief agencies shall strive to get out of the political arena and give priority to relief, assistance and recovery activities. This can be achieved through the compliance with the humanitarian principles such as non-discrimination and impartiality, and through sharing information and analysis related to livelihoods situations.
C. Even if we lose that argument NGOs will focus exclusively on communal areas, ignoring the problem.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.23 [T Chenoweth])
Another aspect of the politicization of the assistance is that donors and NGOs focus almost exclusively their assistance on communal areas. In 2003, Save The Children UK called “donors and humanitarian agencies to apply the humanitarian principle of need and impartiality in implementing their programmes, and [to] include resettlement areas in their activities.” 10 Indeed, donors have been generally opposed to support programmes in these areas, in line with their opposition to the land reform process. Apparently, NGOs were also reluctant to intervene because of donors’ influence but also because of their fears around the highly controversial nature of the land reform programme.
5. Alternate causality – the health system is failing and fueling emergence of other diseases.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.10 [T Chenoweth])
The lack of resources but also the decline of the health system explain these figures; as a matter of fact, the quality and the access to health services in Zimbabwe have been deteriorating over the recent years as a result of under funding, emigration of health staff, and the impact of HIV/AIDS. The maternal mortality ratio, a good indicator of the quality of health services, deteriorated from 610 per 100,000 live births in 1994 to 1100 per 100,000 live births in 2000. Child mortality has doubled from 59 to 123 per 1,000 live births between 1989 and 2004 13. Besides, a number of infectious and epidemic prone diseases have re-emerged in the past few years: • one of the country’s worst ever years as regards malaria was 2003-2004, as a result of failure of the main prevention programme of residual spraying. Already this year there have been more than 650,000 cases and more than 1000 deaths. • cholera has occurred in Zimbabwe every year since 1998, with very high case fatality rates during outbreaks. • Zimbabwe is one of the most affected countries as regards tuberculosis: incidence has increased five-fold between 1992 and 2002. The rise has been attributed mainly to HIV; 80% of TB cases are estimated to be HIV positive. • lastly, rabies and anthrax have made major comebacks as a direct result of the current decline in the capacity for the health care delivery services. Prevention of both diseases required strong intersectoral action, which is currently lacking, regular and widespread vaccine availability and appropriate prevention and control programmes.
6. NGOs fail – health assistance in Zimbabwe is only effective through a governmental framework.
Action Contre la Faim – Your Author, 1-2006 (“Zimbabwe: insight into the humanitarian crisis and food politics,” PDF from - http://www.kubatana.net/html/archive/foodse/060504acf.asp?sector=FOODSE p.23 [T Chenoweth])
A last crucial difference in the way assistance is provided to Zimbabwe compared to other countries in the region is that funds are channelled mainly, if not only, to non governmental channels such as NGOs and UN agencies. Yet, certain sectors, especially health, but also education or agriculture can hardly make any progress out of a governmental framework.
7. Turn: NGOs fail – subcontractors will cause the plan to backfire – they purposely fail to ensure continuing business.
Roger Bate, Economist Roger Bate researches U.S. aid policy in Africa, evaluating USAID, Areas of focus: health policy and endemic diseases in developing countries (more quals can be added); 1-07 (“USAID's health challenge: improving US foreign assistance,” Journal Of The Royal Society Of Medicine Volume 100:29-33, http://www.jrsm.org/cgi/content/full/100/1/29 [T Chenoweth])
USAID provides technical guidance to poor countries' health departments in public health policy and pharmaceutical procurement—as well as very strong support for family planning programs. But it has not been that effective, and a key reason is that the Administrators of USAID have always had their hands tied in several ways. After the Cold War, the conservative hold on US Congressional power meant that foreign assistance was largely justified by ensuring that it benefited US taxpayers and employed the competitive advantages of the private sector. But this approach has unintentionally backfired. As concerns about serious corruption in developing countries led USAID away from ‘budget support’ and similar programs, USAID was reoriented to employ primarily US contractors and continue to source development commodities in the US. These for-profit organizations understandably refused to lower chances of future contracts by actually building local capacity in any meaningful way. And without the resources or political will at USAID to measure performance, contractors also neglected to purchase key commodities and demonstrate efficacy. They simply promoted, and often did not actually buy, the drugs to treat disease. Furthermore, as the contractors became larger and more able to exploit the contract system of USAID, tendering became less competitive. To make matters worse, the ability of the current Administrator, Randall Tobias, to effectively juggle USAID's health priorities among eighteen separate aid accounts addressing health issues and food aid programs, as well as navigate counter-narcotics assistance and military training, is by no means assured—especially since he does not control all of them. The apparent systemic incoherence among US aid programs makes the likelihood of further fragmentation within USAID's disease control programs, as well as the politicization of aid delivery, quite possible.10 Randall Tobias may well possess the coherent vision and sound technical knowledge that his position requires, but it is possible that, amid competing demands in the US's ever-evolving foreign aid policy, success may evade him.
8. Alternate causalities – conflict, development, debt, politics, and class divisions all fuel the AIDS crisis.
Andrew Price-Smith, assistant professor of Environmental science and policy, and John Daly – Your Authors, associate professor of public administration, July 2004 (Downward Spiral HIV AIDS State Capacity and political conflict in Zimbabwe, http://www.usip.org/pubs /peaceworks/pwks53.pdf
4. Reexamine development priorities. As noted above, certain development projects (notably, large construction projects) frequently take men away from their families, leading to widespread demand and opportunities for commercial sex. A pilot project in Cameroon created special camps where workers could live with their families, reducing the incentive to engage in risky behavior. USAID and others should include similar practices within their major construction project proposals (e.g., for dams, road construction, and other major infrastructure improvements). Moreover, U.S. development aid to regions where HIV/AIDS is flourishing should include specific strategies to reduce risky sexual behavior. 5. Invest in education. The United States should provide targeted assistance to reduce school fees, which will help families who have lost a breadwinner to keep their children in school. The education of AIDS orphans is vital to prevent future criminality and radicalization and to foster a productive and hopeful future for these dispossessed youth. Targeted assistance programs should be created to provide the basic necessities of life and develop human capital within orphan cohorts. 6. Preservation of smallholder agriculture. Indigent farms in rural sectors of southern Africa serve as the primary food source for their households. In the early years of this century, families in Zimbabwe and other southern African nations have had to contend with the consequences not only of the HIV/AIDS epidemic but also of drought. HIV/AIDS denudes household resources (both financial and labor) and inhibits house members from planting, tending to, and harvesting their crops. The catastrophic effects of the HIV/AIDS epidemic on subsistence families have been compounded by climatic conditions, with the result that the Zimbabwean countryside is fast becoming populated by widows and orphans. The United States and its allies should advocate the extensive revision of land-tenure arrangements to help protect these families. Donor countries should also emphasize crop diversification and improved access to essential production factors, such as land, labor, capital, management skills, and draft animals. The U.S. government can also offer direct assistance through the Peace Corps and through U.S. Department of Agriculture programs designed to help these families. 7. Promote sustainable distribution of resources within Zimbabwean society. The magnitude of the HIV/AIDS epidemic is likely to further widen class divisions within Zim-babwe and intensify deprivation for the lower and middle classes, who bear the greatest burden of the disease. As the severity of the disease increases and suffering grows more widespread, society as a whole may adopt an attitude of living for today and neglect-ing the future. Such an atmosphere breeds lawlessness and a loss of respect for the interests of others, which in turn encourages societal breakdown. If further erosion of the cohesion of Zimbabwean society is to be avoided, the United States and other donor countries must advocate greater distribution of economic resources to offset the growing sense of hopelessness and injustice. Highly skewed distributions of basic resources (e.g., food, shelter, education, and medical care) seriously undermine the stability of the social order. Moreover, recent research suggests that increasing equity in the national distribution of income will slow the further spread of disease throughout affected societies.80 8. Develop improved partnerships within the private sector. Zimbabwean NGOs and community health service organizations should be encouraged to collaborate more closely with Zimbabwe’s business community. NGO-business partnerships can be designed to promote greater educational awareness about HIV/AIDS, to provide a mechanism for victim and family counseling, and to encourage destigmatization of individuals infected with the disease. The United States can take the lead in this area by encouraging U.S. corporations active in southern Africa (e.g., Kellogg, Coca-Cola, and Microsoft) to continue sharing their resources and expertise to help promote administrative efficiencies and improved program service delivery within the business sector. Zimbabwean businesses stand to benefit from these partnerships by maintaining a more productive workforce, reducing the costs to themselves and their employees of health care, and improving planning for the eventual outplacement and replacement of employees in declining health. 9. Foster peace in sub-Saharan Africa. Conflict often serves as a disease amplifier, with deployed troops acting as vectors for disease transmission. Certainly, the myriad conflicts now being fought in Africa foster the expansion of the HIV/AIDS epidemic. The United States should increase its mediatory efforts to bring peace to the region. Such a strategy would not only promote stability and democracy in southern Africa but also facilitate the containment of the epidemic by reducing the need for troop deployments. At the same time, the United States should expand its collaborative programs with African military forces to educate soldiers about HIV transmission and safe-sex practices, and should promote mandatory testing for all members of the armed forces. Although UN legislation prohibits HIV-infected forces from serving as UN peacekeepers, this rule is often ignored, and thus peacekeeping forces often serve as vectors of transmission. The United States should do all it can (e.g., through the provision of technical support and support for further research) to ensure that all participants in multilateral peacekeeping operations are free of HIV/AIDS and other communicable diseases. 10. Support debt relief. Endogenous efforts to bring the HIV/AIDS epidemic under control are severely inhibited by the high levels of international indebtedness plaguing developing countries in general and sub-Saharan African countries in particular. Servicing those debts draws monies away from programs and institutional sectors—such as education and health—that can alleviate the spread of HIV/AIDS. The U.S. government should make a high priority of a strategy of debt relief for seriously affected countries (which might be defined as nations with HIV seroprevalence levels above 5 percent). Such relief should be contingent on the redirection of funds toward HIV/AIDS suppression—in essence, swapping debt relief for AIDS relief. Similar strategies have been used to encourage countries to protect endangered ecosystems. In the case of Zimbabwe, debt relief should be contingent on government reforms to bring Zimbabwe in line with accepted international democratic practices (e.g., freedom of speech and association, adherence to international human rights standards, and transparency in the use of government resources). Offers of debt relief should continue to be communicated through unofficial and secondary lines of communication (e.g., through other southern African governments) and should stress that the price of debt relief is political reform. 11. Foster political leadership in Zimbabwe in the war against HIV/AIDS. Preliminary evidence suggests that the advocacy of prevention by endogenous political elites is extremely successful in reducing HIV infection rates. The most successful models for the developing world are presently Uganda and Thailand, where political elites have used their power to educate the population and have encouraged an environment to support initiatives that control the spread of HIV without violating individual rights. The United States and its allies should encourage the Mugabe regime to adopt the Ugandan model of HIV suppression, which seems to be highly effective in societies of moderate to low state capacity. This would involve the mobilization of political elites (both ZANU-PF and MDC) to spread the word throughout the country about how to lower transmission rates through behavioral modification. Requisite programs would include education, voluntary counseling and testing, promotion of safe-sex practices, treatment of other STDs that act as gateways for HIV transmission, and increased efforts to destigmatize the disease and to promote basic human rights.